Lindahl Jan, Laitinen Minna, Gänsslen Axel, Krappinger Dietmar, Kiiski Juha, Staresinic Mario
Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.
University of Helsinki, Helsinki, Finland.
Arch Orthop Trauma Surg. 2025 May 2;145(1):279. doi: 10.1007/s00402-025-05850-8.
Traumatic hemipelvectomy (TH) is a rare and extremely severe injury of the pelvic area, which is often life-threatening and associated with a high mortality rate. Individual treatment is focused on the pelvic fracture and the type of accompanying injuries. The management of these severely injured patients places a considerable challenge on the resuscitation team. Patient management should be aggressive from the start. Current literature is focused predominantly on survivors, with only few case series providing possible treatment recommendations. Aggressive initial treatment is focused on standardized damage-control procedures during the prehospital, emergency room, and initial surgical phase to prevent exsanguination and contamination; a massive transfusion protocol should also be initiated immediately to address traumatic coagulopathy. Standard vascular treatment addresses the vascular injury. Colostomy is often recommended for adequate soft-tissue trauma management. Attempts at limb salvage often result in higher complications rates with non-functional limbs compared with completion of the TH. Thus, in cases of critical ischemia and identified relevant sacral nervous plexus injury during initial debridement in predominantly open injuries, primary completion of the hemipelvectomy is recommended. Level of Evidence: IV.
创伤性半侧骨盆切除术（TH）是一种罕见且极其严重的骨盆区域损伤，常危及生命，死亡率很高。个体化治疗侧重于骨盆骨折及伴随损伤的类型。对这些重伤患者的救治给复苏团队带来了相当大的挑战。从一开始就应对患者进行积极治疗。当前的文献主要聚焦于幸存者，只有少数病例系列提供了可能的治疗建议。积极的初始治疗侧重于在院前、急诊室和初始手术阶段采用标准化的损伤控制程序，以防止失血和感染；还应立即启动大量输血方案以应对创伤性凝血病。标准的血管治疗针对血管损伤。为了充分处理软组织创伤，常建议行结肠造口术。与完成TH相比，保肢尝试往往会导致肢体无功能的并发症发生率更高。因此，在主要为开放性损伤的初始清创过程中，如果出现严重缺血且确定存在相关骶神经丛损伤，建议一期完成半侧骨盆切除术。证据级别：IV级。
